Growing number of adults diagnosed with ADHD

Rebekah Sprecher was 27 when a medical work-up revealed a surprising diagnosis: attention deficit hyperactivity disorder, or ADHD, typically considered a childhood condition.

"At first, I thought it was crazy, and then I started talking to my mom and friends, and we realized it's always been there, but we couldn't put a label on it," the San Jose woman said.

With time and therapy, Sprecher, now 38, has learned to embrace her label. Understanding ADHD has helped her reconcile her past and gain control of her adult responsibilities.

About 4 percent to 6 percent of adults in the United States suffer from ADHD, said Shashank Joshi, a child and family psychiatrist at Stanford University. In nearly all cases, adult ADHD represents the continuation of a childhood condition. "It's rare for an adult that walks in to say, 'For the first time when I went to college, I started having these problems,' " Joshi said.

According to the U.S. Centers for Disease Control and Prevention, about 8 percent of school-age children -- an estimated 5 million children -- have been diagnosed with ADHD. About half to two-thirds of those children experience symptoms as adults, according to Joshi. But popular belief and clinical guidelines are still catching up to the scientific evidence.

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Spotting the condition

Last year, for the first time since 2001, the American Academy of Pediatrics revised its guidelines for ADHD. Among other changes, the association extended the age range for diagnosis -- previously 6 to 12 -- to 4 to 18.

ADHD symptoms change with age as the brain matures, but many adults also find workarounds -- social or professional adjustments -- that mask or minimize the disease's effects, said Keith McBurnett, a clinical psychologist at UC San Francisco. In some cases, the subtler signs can make it harder for doctors and adult patients such as Sprecher to spot the condition.

As a child, Sprecher thrived socially but struggled academically. She often failed to complete her homework, performed poorly on tests and nearly flunked high school. Eventually, Sprecher took a smattering of college classes but never got a degree.

"When I was a kid, it was just confusing, or I felt like a failure," she said. That frustration followed her into adulthood, as she tried unsuccessfully to advance her career.

As the name suggests, ADHD involves two main problems -- inattention and hyperactivity.

Hyperactivity tends to subside with age, partly because adults learn to conform to social conventions. "Climbing on things, running in halls, grabbing things when you're not supposed to -- all of that gets better," McBurnett said.

Most ADHD adults can subtly fidget their way through long meetings, checking their phones, tinkering with their briefcases, or getting up frequently to use the bathroom.

Inattention, however, tends to persist. Adults with ADHD often have difficulty keeping schedules, managing time and following through with tasks, McBurnett said.

At the time of her diagnosis, Sprecher had recently been promoted, but her new responsibilities piled up and quickly overwhelmed her. After a nine-month probation period, Sprecher was returned to her old job. She never admitted her condition to her employers.

"I was ashamed. I thought there was something wrong with me, and I didn't want it to be an excuse," Sprecher said.

Now, she works part time as a clerk for the San Jose Public Library and sells toys and books online part time. This summer, she plans to study court reporting a few days a week at West Valley College.

"I kind of dabble," Sprecher said. "It's easier for me to work part time rather than do one thing all day."

Dealing with illness

The single mother of three juggles her jobs and parenting with help from the drug Strattera. And Sprecher keeps up with techniques she learned in therapy, such as writing down notes and schedules every day.

"I have to really be disciplined about getting things organized ahead of time,'' Sprecher said. "The meds help to pull it all together and remember stuff."

Most ADHD medications work by increasing the activity of one or both of two chemicals, dopamine and norepinephrine. Among many other roles, these chemicals may help certain brain circuits control attention, manage impulses and make decisions.

Scott Thomas, 41, of Morgan Hill also suffers from ADHD, but he's decided against taking medications. In college, he managed his condition with the drug Norpramin. He said the gains in concentration and productivity were outweighed by negative side effects.

"The problem is that it turns you into kind of a robot. You lose all facets of your personality, and you're just a focused person in doing whatever you need to do," Thomas said. "I became someone else I didn't know and wasn't familiar with."

Most days Thomas has trouble focusing and staying motivated in his job as a business developer for a materials inspection company. Staying active outside of work helps. "I've been playing drums for the past 20 years," he said. "That's probably the best natural drug for someone that has ADHD."

Norpramin, an antidepressant, is not commonly prescribed for ADHD these days, but current medications can have similar side effects. For the 15 percent to 20 percent of patients who do not benefit from ADHD medication, Joshi emphasizes the importance of a good talk therapist. Both Joshi and McBurnett agreed that the best treatment for most people involves a well-managed combination of medication and therapy.

Sprecher hopes that court reporter training will help her break into a career in closed captioning. Her latest plan takes her ADHD into account and involves helping deaf and hard-of-hearing people, while working in short bursts no longer than a television program.

Joshi points to a number of high-profile individuals -- Jet Blue Airways founder David Neeleman and Kinko's founder Paul Orfalea -- who have succeeded despite, or by their accounts, because of their ADHD.

"I think the most important thing we have to give to people with ADHD is hope," said Joshi. He added, "It's a very common condition, and help is out there."

Contact Helen Shen at 408-920-5064.

HOW TO GET HELP

CHADD is a nonprofit organization that helps children and adults with attention deficit hyperactivity disorder. Information on the group is available at www.chadd.org.